目的 分析替格瑞洛在氯吡格雷抵抗急性心肌梗死患者经皮冠状动脉介入治疗(PCI)术后抗血小板治疗中的应用效果.方法 选择商丘市第一人民医院于2015年2月~2016年8月收治的行PCI的急性心肌梗死患者80例,其中男性43例,女性37例,所有患者均氯吡格雷抵抗.随机将80例患者分成对照组和实验组,均为40例,两组于PCI术前后均给予阿司匹林,在此基础上,实验组在PCI术前给予替格瑞洛,术后给予常规剂量维持,治疗7 d.分别于PCI术前和术后检测血小板聚集率,血肌酐以及谷草转氨酶,并记录不良反应情况.随访6个月,记录主要不良心脑血管事件.结果 术后2 h、1 d以及7 d,实验组血小板聚集率均显著低于对照组,差异有统计学意义(P均<0.05).术后两组血肌酐水平均高于术前,实验组血肌酐水平高于对照组,差异有统计学意义(P均<0.05).对照组、实验组的主要不良心脑血管事件发生率分别为25.0%(10/40)和5.0%(2/40),实验组显著低于对照组,差异有统计学意义(P<0.05).对照组不良反应发生率为5.0%,低于实验组的12.5%,差异有统计学意义(P<0.05).发生不良反应的患者反应时间较短,可耐受,中断治疗可终止.结论 替格瑞洛在氯吡格雷抵抗急性心肌梗死患者PCI术后抗血小板治疗中,可显著抑制血小板聚集,且不良心脑血管事件发生率较低,不良反应患者可耐受.
Objective To analyze the applicative effect of ticagrelor in postoperative antiplatelet treatment in patients with acute myocardial infarction (AMI) and clopidogrel resistance after PCI. Methods AMI patients (n=80, male 43 and female 37) undergone PCI were chosen from the First People's Hospital of Shangqiu City from Feb. 2015 to Aug. 2016. All of them suffered from clopidogrel resistance. All patients were randomly divided into control group and test group (each n=40), and given aspirin before and after PCI. The test group was additionally given ticagrelor before PCI and routine maintenance dose of ticagrelor after PCI for 7 d. The levels of platelet aggregation rate (PAG), serum creatinine (SCr) and aspertate aminotransferase (AST) were detected and adverse reactions were recorded before and after PCI. The patients were followed up for 6 months to record major adverse cardiovascular and cerebrovascular events (MACCE). Results The level of PAG was significantly lower in test group than that in control group (all P<0.05) after PCI for 2 h, 1 d and 7 d. The level of SCr was higher in 2 group after PCI than before, and was higher in test group than that in control group (all P<0.05). The incidence of MACCE was 25.0% (10/40) in control group and 5.0% (2/40) in test group (P<0.05). The incidence of adverse reactions was 5.0% in control group and 12.5% in test group (P<0.05). The adverse reactions were short, tolerable and terminable after discontinuing treatment. Conclusion Ticagrelor can significantly inhibit PAG, incidence of MACCE is lower and adverse reactions are tolerable in postoperative antiplatelet treatment in AMI patients with clopidogrel resistance after PCI.